Selective Mutism (SM) is an anxiety disorder that may feel confusing and overwhelming, but can be treated. It’s a condition in which children are unable to speak in certain situations, even though they’re often very talkative at home!
Symptoms of SM include:
Being talkative and even gregarious at home, but completely or mostly nonverbal at school or around strangers
Seeming “paralyzed” with fear, or “shut down” when unable to speak
Some use gestures, facial expressions, and nodding to get by; others have difficulty communicating even nonverbally
Mythbusting!
There are lots of myths about Selective Mutism. Here are some of the most common:
Myth #1: Kids with SM are just shy and they will grow out of it
Truth: SM is an anxiety disorder that is much more extreme than ordinary shyness; it’s a paralyzing inability to speak which interferes with a child’s life and development. Some children with SM can not even tell an adult if they are hurt, sick, injured, or soiling themselves. While some few children do eventually overcome SM without treatment, they may endure years of suffering and miss out on age-appropriate activities and development.
Myth #2: SM is a result of trauma or abuse
This is an unfortunate myth because it may prevent parents from seeking help for a child for fear of being suspected of abuse. While a child who has SM might also have experienced trauma, there is no evidence to suggest that selective mutism is caused by trauma.
Myth #3: Kids with SM are refusing to speak, being oppositional, being manipulative, or just not trying hard enough
The idea that children “choose” selective mutism was such a popular idea that for a while SM was known as “elective mutism,” and it was sadly attributed to poor parenting. The truth is that SM stems from social anxiety and inhibition, not anger or a desire to control; the children experience it as an inability to speak. Children with SM are not “refusing” to speak, they’re not trying to manipulate you, and they usually are trying very hard- even though we can’t always see it.
Myth #4: Kids with SM have speech problems
While some children with SM do have a speech delay, the two conditions are unrelated and many selectively mute children have no speech or language delays. When children cannot speak to unfamiliar adults, their verbal skills may be underestimated or misunderstood.
Myth #5: Kids with SM just need the adults to make clearer commands or be more persuasive
Pressure to speak is precisely what children with SM find most paralyzing. They need therapeutic interventions to reduce anxiety and encourage efforts to speak with positive reinforcement. However, being careful to give a child 5 seconds extra time to respond to a question can increase the chance that they will answer.
Myth #6: SM is a form of Autism
Children with SM, when they are feeling anxious, often react with lack of eye contact, a blank expression, and other behaviors that may look like Autism. However, SM is fundamentally different from autism; while children with autism lack social and communication skills, children with SM are severely inhibited in speaking only in certain situations.
What are the treatment options for a child with Selective Mutism?
There are a few different options for those affected by SM. Science strongly supports a combination of medication and behavioral therapy to treat SM. In my practice, I most often use Cognitive Behavioral Therapy, Gradual Exposure Therapy, and Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM). I work with each family individually to collaborate on a customized plan that is unique to each situation.
What is PCIT-SM?
Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM) is a scientifically validated treatment that increases verbal communication and equips parents/caregivers/teachers to help their child overcome SM. It is an adaptation of PCIT, which is a gold-standard treatment recognized by numerous professional organizations for the effective treatment of young children who struggle with self-control.
PCIT-SM is split into two distinct phases.
Desired outcomes of the first phase of treatment in PCIT-SM include:
Decreased anxiety
Increased self-confidence and self-efficacy
Increased warmth and confidence with people
Decreased parental frustration
Increased feelings of security, safety, and attachment to the primary caregiver
Increased self-esteem
Increased pro-social behaviors (such as sharing and taking turns)
Decreased disruptive/negative behaviors (if applicable)
The second phase of treatment will equip parents/caregivers to help their child overcome anxiety while remaining confident and calm. It will teach them how to break the cycle of anxiety that worsens Selective Mutism and practice “brave talking” with new people and in new situations.
Desire outcomes of the second phase of treatment in PCIT for anxiety include:
· Increased self-efficacy and self-confidence related facing anxiety-provoking situations
· Increase verbal communication with teachers, peers, and other adults
· Decreased fear-responses when facing anxiety-provoking situations
· Increased ability to quickly calm down when anxious or afraid
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